"What about marijuana?"
It's a question that likely will soon be posed by a growing number of patients in more and more doctors' offices across the country.
Revamped federal regulations governing access to medical marijuana officially take effect this week, and Health Canada projects the number of users will balloon from the current 38,000 to 450,000 within a decade, based on recent growth rates.
As of Tuesday, federal authorization to possess medicinal pot for patients with chronic pain, multiple sclerosis and a variety of other ailments will shift from Health Canada to physicians, who will be responsible for writing prescriptions for the drug if they so choose.
Under the new program, those prescriptions will allow patients to purchase up to 150 grams of dried weed each month – ideally, in the government's view – from licensed commercial growers that are setting up shop across the country.
Indeed, that was a key intention of the amended Marihuana for Medical Purposes Regulations (Health Canada spells marijuana with an "h"). Only regulated and inspected producers would be allowed to sell quality-controlled weed for medicinal purposes, making it illegal for patients or their current suppliers to operate even small, home-based grow-ops.
But the plan went up in smoke March 21, at least temporarily, when a B.C. federal court judge granted an injunction allowing anyone currently licensed under the sun-setting rules to continue growing plants until a constitutional challenge mounted by a group of patients is heard.
Even without that legal wrinkle, the seismic shift in how Canadians can obtain cannabis has polarized the medical community and left many questioning how easy it might be for recreational users to abuse the system – and the trust of doctors who are its gatekeepers.
John Goodhew, who has been helping patients access medical marijuana since the mid-1990s, says the new setup and attendant media attention will likely mean a flood of requests for the drug.
"This is patient-driven, not doctor-driven," Dr. Goodhew said. "So it's seldom that I'm going to have a patient in my office who has something and I'm going to say: 'Hey, why don't you try marijuana?' That's really not the way it happens," explains the primary-care doctor, whose downtown Toronto practice includes about 300 patients with HIV.
"It comes down to the reason somebody wants to use it."
While weed contains the psychoactive ingredient THC (tetrahydrocannabinol), there are hundreds of other compounds in the plant that may have remedial effects: Many people with HIV or cancer use pot to stimulate their appetite to prevent wasting and to combat nausea caused by the drugs fighting their disease.
People with MS who use pot say it helps relieve muscle spasticity; some people with epilepsy attest that marijuana reduces their seizures; while others with chronic pain report the drug eases their suffering.
One positive aspect of the new rules, Dr. Goodhew offers, is that they do away with administrative red tape, allowing the doctor to judge whether a patient might benefit from cannabis when conventional pharmaceuticals have failed to provide relief.
"I have many patients in my practice who use medical marijuana, but it's in the context of comprehensive, ongoing care I provide my clients," said Dr. Goodhew, contradicting any notion he is a Dr. Dope.
"So people can come in with any condition and say: 'Sign me up for marijuana.' But likewise they can come in for many conditions to have OxyContin prescribed – I'm not going to prescribe it," he says of the highly addictive painkiller, recently replaced by a more tamper-proof pill called OxyNeo.
"It's going to have to be appropriate. I'm still going to be looking for some of the key symptoms that we know marijuana helps with, things like nausea, weight loss, muscle spasticity, epilepsy and chronic pain, of course."
Yet doctors' groups, including provincial Colleges of Physicians and Surgeons, are cautioning members against prescribing the drug, primarily because of uncertainties about its effects. Doctors, they stress, are under no obligation to authorize any patient to use marijuana.
The College of Family Physicians states on its website that Health Canada is placing doctors in an "unfair, untenable and to a certain extent unethical position by requiring them to prescribe cannabis." It also warns that physicians could be held legally liable if the patient suffers a cannabis-related harm, "just as they are with other prescribed medications."